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General NPI Number Information
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NPI Number | 1477991073
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Entity Type | Organization
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Legal Business Name | M & D LEGACY
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Dates
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Enumeration Date | 06/06/2013
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 9244 GATEWAY BLVD E STE A
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City | EL PASO
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State | TX
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Zip | 79907-1848
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Country | US
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Telephone | 915-213-5490
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Fax | 915-213-3285
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Provider Business Mailing Address
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Address Line | 9244 GATEWAY BLVD E STE A
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City | EL PASO
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State | TX
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Zip | 79907-1848
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Country | US
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Telephone | 915-213-5490
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Fax | 915-213-3285
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | GIANNI BALLOU
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Credential |
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Telephone | 915-213-5490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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